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Inside the Lab Profession, Training and education, Digital and computational pathology

A Natural Gift for Pathology

What inspired you to pursue pathology?

When I was a medical student, there was a second-year course in pathology. The teachers were the best I’d had, so they strongly influenced my choice. As part of the course, we each had a microscope and a pile of old, dingy slides on which we were supposed to identify disease entities. Somehow, I ended up as one of the students who went around explaining to everyone else what they were supposed to be seeing. Whatever wiring is required to look at a microscope slide and understand it, I seemed to have it – and liked doing it!

Within a week of starting my residency at the University of Michigan, I decided that the smartest people on the faculty were Henry Appelman, a world-famous gastrointestinal pathologist, and Sharon Weiss, a world-famous soft tissue pathologist. I said, “Whatever they do, that’s what I’m going to do.” I didn’t know a thing about GI or soft tissue pathology, but I did know I wanted to learn from them.

How did you get so involved in pathology education?

When I first began to speak publicly, I was terrible at it. I was always nervous; I couldn’t catch my breath; I think I might even have taken a beta blocker the first time I had to get up in front of an audience! Eventually, though, I learned to like it, and now I really enjoy it. I get a great deal of satisfaction from lecturing – even if the listeners only take away a small amount of useful information. I try not to include too much, and I don’t expect people to remember all of it. When I’m sitting in the audience, I’m happy to take away one or two valuable points; that’s what I would like others to be able to do when I teach.

With respect to textbooks, in 1997, Franz Enzinger decided he was not up to working on the fourth edition of the Enzinger and Weiss soft tissue pathology book. Sharon Weiss asked me, as one of her former fellows, if I would be willing to take his place. I didn’t think I was in a position to do it, but she said, “You can do it. I trust you.” And so I also wasn’t in a position to say no! It was the first time I had ever written a textbook, so it took me about three years to finish. It was good practice, though, because my friend Rob Odze had the idea of working on a GI textbook with me. Eventually, the powers that be at Elsevier asked me to take over the 11th edition of the Rosai and Ackerman textbook on surgical pathology. You can imagine the scale of that task! I gathered three other world-class people to help me and it took us about five years, but we did it.

The most important thing to remember is to be a good colleague and team player.

How do you maintain your work/life balance?

When I started at the Cleveland Clinic, it was extremely busy – but I was a young parent who didn’t want to stay at work all day and night and never see my wife and children. My father was a hardworking dermatologist who rarely had time to spend at home, and although I admired his dedication, I didn’t want to replicate it – so I tried to become exceedingly efficient at multitasking. When I’m at work, I run around like a maniac to get everything done. I keep breaks and socializing to a minimum so that I can accomplish what I need and then go home to my family.

I am hoping it’s not going to be that long before I can sign out my cases from anywhere, which I expect will really help those who struggle with work/life balance. I already do a number of consults from China and other parts of the world digitally, and they’re only a little more challenging than using the microscope, so I think we’re inching closer. I hope that, in my lifetime, we get to that point – it’s my goal to sign out cases from the beach!

What do you consider the high points of your career?

My biggest accomplishment is taking my department from 15 people and a limited reputation to a very large subspecialty department with an international reputation and about 70 pathologists. It’s a job I only reluctantly accepted, but I ended up really liking it and building what I think is a tremendous department.

I’m also very engaged with organizational pathology. I got involved with USCAP early in my career and ended up running their education committee for six years and serving on the committee for 14 years. Eventually, I joined the board and became President of USCAP – and I’m still involved with them now. That’s the other thing that makes me proud, because I believe that I not only derived tremendous personal and professional benefit from USCAP, but I feel I actually contributed to the organization’s progress at a critical time.

What’s your advice for young pathologists?

The most important thing is to remember is to be a good colleague and team player. That’s how you’re going to end up loving your job – by working with people whose company you enjoy. The people who are most successful in pathology are those who really like both the profession and the people they work with.

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